Varicocele

A varicocele refers to one or more enlarged veins in the scrotum, the loose pouch of skin that contains the testicles. Similar to a varicose vein in the leg, varicoceles are caused by a defect in one or more valves that help the blood to flow upwards. The defective valve causes blood to pool, making the vein swell. Affecting about 20% of men aged 15 to 25, varicoceles usually develop above the left testicle and occasionally in both testicles.

While a varicocele often causes no symptoms, it is the most common cause of sperm production problems that can lead to male infertility. Some 40% of infertile men have a varicocele and about 80% of those who have already fathered a child but are now infertile have one.

Risk Factors

The only known risk factor is being a male over the age of 15.

Symptoms

Most varicoceles do not cause symptoms and often go unnoticed until a physical exam or a fertility work-up. Symptoms may include:

Aching or feeling of heaviness in the testicle, especially after standing for a long time

Atrophy (shrinkage) of the testicle

Visible or palpable enlarged veins that may look like "a bag of worms"

Infertility

A mass in the scrotum

Doctors suspect that varicoceles can cause infertility in some men by raising the temperature in the testes, which may damage or destroy sperm. However, many men with varicoceles do not have fertility problems.

Diagnosis

In most cases, your doctor can detect the varicocele through a physical exam. He may ask you to take a deep breath and bear down (called the valsalva maneuver) to improve detection. If the exam is not conclusive, he may order an ultrasound of the testicles to provide a painless view of their internal structures.

Treatment

Most varicoceles don't require treatment. If you experience pain or atrophy of the testicle or if you are infertile, you may wish to undergo one of several treatments:

Open surgery - the most common procedure to treat varicoceles. An incision may be made in your groin (inguinal canal), in your abdomen or below your groin so that your urologist can tie off the affected vein(s) and allow blood to be redirected to the unaffected veins. The outpatient procedure usually involves local anesthesia and few complications. A small percentage of men may get hydrocele (fluid build up in the testicle) or have a recurrence of the varicocele.

Laparoscopy - less often used because it can present more risks. This procedure may have the advantage of identifying veins higher up, where your surgeon likely will need to tie off fewer veins. The urologist makes several tiny incisions in your abdomen, using tiny instruments under general anesthesia to repair the varicocele.

Percutaneous embolization - usually performed when other approaches have failed. A radiologist passes a tube through a vein in your groin to the affected area and releases a coil or balloon to block off the affected vein.

You cannot expect to restore fertility for at least three to four months after the procedure, as sperm take about eight weeks to generate. The procedure does not guarantee fertility; talk with your doctor to fully understand your potential risks and benefits.